Assuntos
Aleitamento Materno , Saúde da Criança , Ásia , Criança , Pré-Escolar , Consenso , Feminino , Humanos , Lactação , Gravidez , Fenômenos Fisiológicos da Nutrição Pré-NatalRESUMO
These are consensus statements on screening for hyperglycemia in pregnancy derived from AOFOG MFM Committee's Hyperglycemia in Pregnancy Consensus Working Group during a workshop in Singapore on 13 January 2018.
Assuntos
Consenso , Ginecologia/normas , Hiperglicemia/diagnóstico , Obstetrícia/normas , Complicações na Gravidez/diagnóstico , Sociedades Médicas/normas , Feminino , Humanos , GravidezRESUMO
PURPOSE OF REVIEW: Intrauterine growth restriction remains one of the major problems in obstetrics. Recent published literature on this problem is summarized in this review. RECENT FINDINGS: Intrauterine growth restriction contributes disproportionately to neonatal mortality and morbidity in both preterm and term babies, and is a predisposing factor to major psychiatric sequelae such as depression, suicide and suicidal attempts. More evidence is accumulating to show that fetal Doppler changes of the ductus venosus and umbilical vein are good surrogate markers for fetal academia. The timing of delivery remains controversial, however. The Growth Restriction Intervention Trial showed that delayed delivery in those up to 30 weeks may be associated with lower rates of cerebral palsy and Griffiths development quotient under 70. In dichorionic twins, selective fetocide of one severe intrauterine growth restriction fetus in midtrimester twin pregnancies complicated by severe preeclampsia may abort the disease process and prolong the pregnancy. For monochorionic twins, the finding of intermittent absent or reversed end diastolic flow in the umbilical artery may be a manifestation of the transmission of the bi-directional waveforms of arterio-arterial anastomosis, but has been shown to be associated with an increased risk of intrauterine death in the growth restricted fetus and brain damage in the larger fetus. SUMMARY: The timing of delivery of the preterm growth restricted fetus remains controversial. Intrauterine growth restriction with intermittent absent or reversed end diastolic flow in the umbilical artery of monochorionic twins poses difficulties in assessment.
Assuntos
Retardo do Crescimento Fetal/diagnóstico , Diagnóstico Pré-Natal/métodos , Corticosteroides/uso terapêutico , Parto Obstétrico/normas , Feminino , Desenvolvimento Fetal , Retardo do Crescimento Fetal/tratamento farmacológico , Retardo do Crescimento Fetal/fisiopatologia , Humanos , Insuficiência Placentária/fisiopatologia , Gravidez , Resultado da Gravidez , Fatores de TempoAssuntos
Transfusão Feto-Fetal/cirurgia , Fetoscopia/métodos , Terapia a Laser/métodos , Resultado da Gravidez , Feminino , Transfusão Feto-Fetal/mortalidade , Seguimentos , Idade Gestacional , Humanos , Mortalidade Infantil , Recém-Nascido , Gravidez , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do TratamentoAssuntos
Amniocentese/métodos , Transfusão Feto-Fetal/mortalidade , Transfusão Feto-Fetal/terapia , Fotocoagulação a Laser/métodos , Estudos de Coortes , Intervalos de Confiança , Feminino , Transfusão Feto-Fetal/diagnóstico por imagem , Humanos , Recém-Nascido , Razão de Chances , Gravidez , Resultado da Gravidez , Gravidez Múltipla , Probabilidade , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Gêmeos Monozigóticos , Ultrassonografia Pré-NatalRESUMO
OBJECTIVE: Treatment selection in twin-twin transfusion syndrome is increasingly determined by disease severity. We investigated whether detection of arterio-arterial anastomoses predicts perinatal survival. METHODS: An artery-artery anastomosis was sought by Doppler and disease stage was determined in 105 cases of twin-twin transfusion syndrome at presentation, first treatment, and worst stage. Outcome measures were perinatal, double, and any (1 or more babies) survival rates. RESULTS: After exclusion of 10 noninformative pregnancies, perinatal, double, and any survival rates were 61%, 44%, and 77%, respectively. When an anastomosis was detected at each of the 3 time points, perinatal and double survival rates were higher than when one was not (at first treatment, perinatal survival 83% versus 53%, respectively, P =.003; double survival 78% versus 33%, P <.001). Perinatal and double survival (P < or =.01) were poorer with more advanced stage, but any survival rates were not influenced by stage or anastomosis detection. Multiple logistic regression demonstrated that anastomosis detection at treatment increased the chance of perinatal (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.6, 15.9) and double survival (OR 19.3, 95% CI 2.7, 138), independently of stage. For stages I-III at treatment, anastomosis detection predicted better perinatal (100% versus 63%, 100% versus 59%, and 83% versus 44%, respectively) and double survival rates (100% versus 52%, 100% versus 46%, and 78% versus 26%). Stage III, with anastomoses detected, had better perinatal (83% versus 63%) and double survival (78% versus 52%) than did stage I without detection. CONCLUSION: Antenatal detection of artery-to-artery anastomosis predicts higher perinatal and double survival in twin-twin transfusion syndrome, independently of disease stage. LEVEL OF EVIDENCE: II-3